Revision of total hip arthroplasty using the Kerboull and KT plates

We reviewed 42 hips which had undergone revision THA between 1995 and 2005 (the Kerboull plate in 24 hips, and the KT plate in 18 hips). Patients were followed-up for a mean of 7.5 years (range 3–13). In the Kerboull plate group, the five- and ten-year survival rates were 89.9% and 79.4%, respectively. In the KT plate group, the five-year survival rate was 87.5%. The Kerboull and KT plates are placed as close as possible to the original acetabular position and used in combination with a bone graft for bone defects. In Japan, for patients with large bone defects, femoral heads with good quality which have been resected due to osteoarthritis are difficult to prepare as bone grafts. Therefore, use of the KT plate can reduce the bone graft volume to a certain extent by high placement, which was effective in our cases

Rotational acetabular osteotomy for advanced osteoarthritis of the hip joint with acetabular dysplasia

Between August 1986 and July 1997, we performed rotational acetabular osteotomy (RAO) according to the methods of Ninomiya and Tagawa in 161 patients (179 hips). Among them, 63 patients (68 hips) had advanced osteoarthritis. We assessed the outcome at a mean of 12 years after rotational acetabular osteotomy was performed for the treatment of advanced osteoarthritis in a series of patients with acetabular dysplasia. Eleven patients did not return for final follow-up and were excluded from the study, leaving 52 patients (57 hips) for analysis. The mean Merle d’Aubigné clinical score improved from 12.6 points (range 9–16) preoperatively to 14.3 points (range 7–18) postoperatively (p < 0.002), mainly because of increased scores for pain. At final follow-up, 50 of the 57 hips were still functioning. The results of rotational acetabular osteotomy for correction of advanced osteoarthritis in adults with acetabular dysplasia were satisfactory after a mean of 12.2 years

Rotational Acetabular Osteotomy for Secondary Osteoarthritis After Surgery for Developmental Dysplasia of the Hip

The treatment of residual deformity following surgery for developmental dysplasia of the hip remains controversial. The rationale for the use of the rotational acetabular osteotomy (RAO) is that it increases the weight-bearing area by shifting the osteotomized acetabulum to cover the femoral head. This can improve joint function as well as achieve relief of pain. However, it is unclear if this osteotomy can improve a compromised hip when performed for the treatment of residual deformity and acetabular dysplasia after surgery for developmental dysplasia of the hip. We aimed to report the clinical outcome as assessed by need for total hip arthroplasty (THA) and by the Merle d’Aubigné and Postel scores. In addition, we tried to assess the radiographic outcomes as assessed by Tönnis’s classification. Only two hips required THA, which was performed in two patients at 11 and 12 years after RAO, respectively. The mean Merle d’Aubigné clinical score improved from 14.1 ± 2.3 points (range, 10 to 17) preoperatively to 15.8 ± 2.9 points (8 to 18) at final follow-up (p < 0.02). Radiological assessment at final follow-up showed the obvious progression of osteoarthritis in five hips. One patient in grade 1 preoperatively progressed into grade 3 at final follow-up; four patients in grade 2 preoperatively progressed into grade 3. In our study, this osteotomy prolonged the functional life of the hip, and only two hips needed THA after a mean follow-up of 11 years. We found that advanced arthritis pre-osteotomy is associated with progression of radiologic change